MR动态增强扫描在前列腺癌诊断及鉴别诊断中的应用价值(英文)

目的通过绘制时间信号强度曲线,探讨 MRI 快速序列动态增强在前列腺癌诊断及鉴别诊断中的价值。方法对5例无泌尿系症状健康对照者、13例经病理证实的前列腺癌及36例前列腺增生行 MR 平扫、动态增强及延迟扫描,测量并计算病灶和正常组织的相对信号强度值,并绘制正常周围带、前列腺癌与增生三者的时间信号强度曲线。结果正常周围带轻度强化,并缓慢上升至晚期达峰值;36例前列腺增生早期明显强化并逐渐上升至中晚期达峰值后缓慢下降;13例前列腺癌中9例早期明显强化,并快速下降,4例 T_2WI 像上弥漫性病灶呈现中晚期强化。结论正常周围带、前列腺癌及前列腺增生的动态强化方式明显不同,应用动态增强扫描可对前列腺癌的诊断与鉴别诊断起积极作用。     

磁共振弥散加权成像及动态增强在前列腺癌诊断中的临床应用价值

目的 研究磁共振弥散加权成像及动态增强在前列腺癌诊断中的临床应用价值.方法 选择疑似前列腺癌进行穿刺活检的患者50例,并选择同期常规体检的健康者30例为对照组.对所有研究对象采取磁共振弥散加权成像以及动态增强检查.观察50例患者的临床病理情况,比较正常前列腺、前列腺癌和前列腺增生的磁共振弥散加权成像信号强度值、表观扩散系数值以及磁共振动态增强扫描参数(血管外细胞外间隙体积百分数、转运常数以及速率常数).结果 50例患者经穿刺病理活检或者手术诊断为前列腺增生24例,占48.00%;诊断为前列腺癌26例,占52.00%;正常前列腺组、前列腺癌组和前列腺增生组三组间进行两两比较发现,前列腺增生组与正常前列腺组磁共振弥散加权成像信号强度值以及表观扩散系数值相比无明显差异,其他各组之间两两比较均有显著性差异(P<0.05);正常前列腺组、前列腺癌组和前列腺增生组三组间进行两两比较发现,前列腺增生组与正常前列腺组血管外细胞外间隙体积百分数、转运常数以及速率常数相比无明显差异,其他各组间两两比较均有显著性差异(P<0.05).结论 磁共振弥散加权成像及动态增强联合使用有助于鉴别诊断前列腺病变,在前列腺癌诊断中具有较高的临床应用价值.     

动态增强MRI结合DWI对前列腺癌的诊断价值

[目的]探讨动态增强MRI结合扩散加权成像(DWI)对前列腺癌(PC)的诊断价值.[方法]对52例临床怀疑为PC者行MR平扫加动态增强、DWI检查,分析各项MRI图像及表观扩散系数(ADC)图并测量ADC值,根据MR平扫、DWI、平扫加动态增强及三者联合分别作出诊断并与临床及病理结果对照.[结果]MR平扫、DWI、平扫加动态增强及三者联合对PC的定性诊断准确率分别为73.1％、84.6％、88.5％、92.3％,分期诊断准确率分别为62.5％、70.8％、75.0％、87.5％.单纯平扫与平扫加动态增强、三者联合的定性诊断准确率有统计学差异(P＜0.05);DWI与平扫加动态增强、三者联合无统计学差异(P＞0.05).[结论] PC在MR动态增强及DWI上有特征性表现,MR平扫结合动态增强及DWI有利于提高PC的诊断准确率.     

3.0T MR动态增强扫描在鉴别乳腺导管原位癌有无微浸润中的价值

目的:探讨3.0T MR动态增强扫描在鉴别乳腺导管原位癌有无微浸润中的价值.方法:研究纳入了经手术或活检证实的52例导管原位癌,按照病理结果分为两组,即单纯导管原位癌组和导管原位癌伴微浸润组.对两组病变的多期动态增强表现进行回顾性对照分析,评价指标包括:强化形态、内部强化特点及时间-信号强度曲线,并对有统计学显著性差异的影像学征象的鉴别诊断价值进行分析.结果:导管样强化多见于单纯导管原位癌组(P=0.01);节段样强化和肿块样强化多见于导管原位癌伴微浸润组(e=0.04,0.03);点簇样强化多见于导管原位癌伴微浸润组(P=0.02);均匀性强化多见于单纯导管原位癌组(P=0.04).速升平台型曲线多见于单纯导管原位癌组(P=0.04),速升缓降型曲线多见于导管原位癌伴微浸润组(P=0.03).病变强化形态的鉴别诊断价值要高于内部强化特点和时间-信号强度曲线,其敏感度、特异度及准确度为76.5％、70.2％和67.7％.结论:3.0T MR动态增强扫描有助于鉴别导管原位癌有无微浸润,尤其病变的强化形态对鉴别诊断有一定帮助.     

MRI动态增强扫描在肝转移瘤诊断及血供分析中的应用(附60例病例报告)

目的:探讨MRI动态增强扫描尤其是动脉期扫描在检测肝转移瘤中的临床意义.方法:回顾性分析60例肝转移瘤560个病灶在MRI动态增强各期的图像表现,计算平扫及动态增强各序列显示的病灶数目,分析其血供类型及强化方式.结果:肝转移瘤在动脉期、门脉期及静脉期的检出率分别为95%、87%、86%;56个富血供转移瘤仅在动脉期显示.52%的乏血供转移瘤和89%富血供转移瘤在动脉期强化更明显.周边环形强化是肝转移瘤在动脉期的主要强化方式.结论:MRI多期增强扫描,尤其动脉期扫描能够较好的检测出肝转移瘤并分析其血供类型,从而为临床治疗方案的选择及预后评价提供参考依据.     

前列腺良恶性病变的高场强MRI诊断价值

前列腺良性增生（benign prostate hyperplasia,BPH）和前列腺癌（prostate cancer,PCa）严重危害老年男性的健康,前列腺增生常合并前列腺癌,早期诊断对于选择有效的治疗方法十分重要。我们对26例前列腺病变患者的MRI资料进行研究,旨在探讨3．0T高场强MRI在前列腺疾病诊断中的应用价值。     

血清cPSA对前列腺癌诊断价值的研究

 目的　探讨血清中结合前列腺特异性抗原 (c PSA)在前列腺癌 (PCa)诊断中的临床价值。方法　用磁微粒子免疫化学发光法测定 72例良性前列腺增生 (BPH)患者和 38例PCa患者c PSA、t PSA ,并计算c PSA/t PSA比值。结果　c PSA及c PSA/t PSA比值可有效地区分BPH和PCa(P <0 .0 0 5 ) ,尤其是在诊断灰值区 (t PSA为 4～ 1 0ng/ml)时效果更显著。在以t PSA≤1 0 .0ng/ml和c PSA/t PSA≥0 .72为筛选界值联合对PCa进行筛选时 ,临床概率敏感度为 93.8%。结论　c PSA的引入及c PSA/t PSA比值的应用 ,对PCa的诊断具有重要临床意义 ,尤其是在前列腺特异性抗原的诊断灰值区。     

磁共振动态增强在乳腺肿块性病变的诊断价值

目的：探讨 DCE - MRI 在乳腺肿块性病变的诊断价值及病生基础。方法：回顾性分析经手术病理证实的乳腺肿块性病变38例,术前接受了乳腺 MRI 动态增强检查,分析病变的形态学及血流动力学改变。结果：38例病变,恶性25例,环形强化或边缘强18例,占72%;64%（16/25）边缘见毛刺,28%（7/25）形态不规则;早期增强率为（89.5±26.7）%;时间-信号强度曲线72%（18/25）为流出型,24%（6/25）为平台型。良性13例,38.5%（5/13）见分叶,46.2%（6/13）光滑;早期增强率为（51.5±22.3）%,76.9%（10/13）为流入型,15.4%（2/13）为平台型;良恶性病变增强形态、早期增强率和时间-信号强度曲线差异有显著性意义（P均﹤0.01）;三者对良恶性病灶诊断的敏感性、特异性分别为92%（23/25）、84.6%（11/13）;88%（22/25）、53.8%（7/13）;96%（24/25）、76.9%（10/13）。结论：环形或边缘强化、毛刺状形态和流出型时间-信号强度曲线均强烈提示恶性;边缘光滑和单相型时间-信号强度曲线均强烈提示良性;早期增强率诊断的特异性较差。     

MRI影像组学在鉴别前列腺癌与前列腺增生中的临床应用价值

目的:探讨基于T2WI与表观扩散系数(apparent diffusion coefficient,ADC)的影像组学模型对前列腺癌(prostate cancer,PCa)和前列腺增生(benign prostatic hyperplasia,BPH)的鉴别诊断应用价值。方法:回顾性分析经穿刺活检病理证实的72例PCa患者与64例BPH患者的临床资料及原始MRI图像。使用ITK-SNAP软件手动勾画整个肿瘤(不包括囊变、出血、坏死及钙化)生成三维体积(VOI),采用FAE软件分别从T2WI与ADC图像提取高通量影像组学特征,应用Pearson相关性分析及循环特征消除(RFE)方法进行特征选择,使用支持向量机(SVM)作为分类器构建影像组学模型。采用分层随机抽样的方法将所有病例按7∶3分成训练集与验证集,通过绘制受试者工作特征(ROC)曲线及校准曲线分析评估各个影像组学模型的鉴别诊断效能与校准能力,并使用Delong检验评价模型间的差异。结果:经过特征选择,分别使用12、15、11个图像特征构建基于T2WI/ADC/T2WI+ADC的影像组学预测模型。训练集中T2WI/ADC/T2WI+ADC影像组学模型的ROC曲线下面积(AUC)分别为0.88、0.92、0.96,验证集中T2WI/ADC/T2WI+ADC影像组学模型的AUC分别为0.85、0.89、0.91。Delong检验显示T2WI+ADC联合影像组学模型鉴别诊断效能显著高于单个序列模型,校准曲线显示联合影像组学模型具有较好的预测能力。结论:基于T2WI+ADC的联合影像组学模型有助于术前鉴别PCa和BPH。     

Differentiation of Benign from Malignant Adnexal Masses by Functional 3 Tesla MRI Techniques: Diffusion-Weighted Imaging and Time-Intensity Curves of Dynamic Contrast-Enhanced MRI

Background: The aim of this study was to evaluate and compare the accuracy of diffusion-weighted imaging(DWI), apparent diffusion coefficient (ADC) value, and time-intensity curve (TIC) type analysis derived fromdynamic contrast-enhanced MR imaging (DCE-MRI) in differentiating benign from malignant adnexal masses.Materials and Methods: 47 patients with 56 adnexal masses (27 malignant and 29 benign) underwent DWI andDCE-MRI examinations, prior to surgery. DWI signal intensity, mean ADC value, and TIC type were determinedfor all the masses. Results: High signal intensity on DWI and type 3 TIC were helpful in differentiating benignfrom malignant adnexal masses (p<0.001). The mean ADC value was significantly lower in malignant adnexalmasses (p<0.001). An ADC value<1.20×10-3 mm2/s may be the optimal cutoff for differentiating between benignand malignant tumors. The negative predictive value for low signal intensity on DWI, and type 1 TIC were 100%.The pairwise comparison among the receiver operating characteristic (ROC) curves showed that the area underthe curve (AUC) of TIC was significantly larger than the AUCs of DWI and ADC (p<0.001 for comparison ofTIC and DWI, p<0.02 for comparison of TIC and ADC value). Conclusions: DWI, ADC value and TIC typederived from DCE-MRI are all sensitive and relatively specific methods for differentiating benign from malignantadnexal masses. By comparing these functional MR techniques, TIC was found to be more accurate than DWIand ADC.     

Radiomics Model for Evaluating the Level of Tumor-Infiltrating Lymphocytes in Breast Cancer Based on Dynamic Contrast-Enhanced MRI

BackgroundTo help identify potential breast cancer (BC) candidates for immunotherapies, we aimed to develop and validate a radiology-based biomarker (radiomic score) to predict the level of tumor-infiltrating lymphocytes (TILs) in patients with BC.Patients and MethodsThis retrospective study enrolled 172 patients with histopathology-confirmed BC assigned to the training (n = 121) or testing (n = 51) cohorts. Radiomic features were extracted and selected using Analysis-Kit software. The correlation between TIL levels and clinical features and radiomic features was evaluated. The clinical features model, radiomic signature model, and combined prediction model were constructed and compared. Predictive performance was assessed by receiver operating characteristic analysis and clinical utility by implementing a nomogram.ResultsSeven radiomic features were selected as the best discriminators to construct the radiomic signature model, the performance of which was good in both the training and validation data sets, with an area under the curve (AUC) of 0.742 (95% confidence interval [CI], 0.642-0.843) and 0.718 (95% CI, 0.558-0.878), respectively. Estrogen receptor status and tumor diameter were confirmed to be significant features for building the clinical feature model, which had an AUC of 0.739 (95% CI, 0.632-0.846) and 0.824 (95% CI, 0.692-0.957), respectively. The combined prediction model had an AUC of 0.800 (95% CI, 0.709-0.892) and 0.842 (95% CI, 0.730-0.954), respectively.ConclusionThe radiomic signature could be an important predictor of the TIL level in BC, which, when validated, could be useful in identifying BC patients who can benefit from immunotherapies. The nomogram may help clinicians make decisions.     

Differentiation of Benign from Malignant Adnexal Masses by Dynamic Contrast-Enhanced MRI (DCE-MRI): Quantitative and Semi-quantitative analysis at 3-Tesla MRI

Background: To evaluate the utility of the pharmacokinetic modeling derived from dynamic contrast-enhancedmagnetic resonance imaging (DCE-MRI) in differentiating benign from malignant adnexal masses. Methods: A total of43 patients with 49 complex adnexal masses (27 benign, 3 borderline, and 19 malignant lesions) underwent preoperativeDCE-MRI examinations on a 3 Tesla MRI. Using extended Tofts’ model, quantitative analysis was performed in thesolid components of all tumors. Three pharmacokinetic parameters were defined as volume transfer coefficient (Ktrans),the rate constant (Kep), and the plasma volume (Vp). Semi-quantitative analysis was also performed and the valuesof relative signal intensity (SI rel) wash-in-rate (WIR), the initial area under the curve (iAUC60), time-to-peak (TTP)and wash-out-rate (WOR) were calculated. Receiver operating characteristic (ROC) curve analysis was performed toevaluate diagnostic characteristics of each DCE-MRI parameter in differentiating borderline/malignant tumors frombenign lesions and to provide the optimal cutoff values for these variables. Results: SI rel had the highest diagnostic value(AUC=0.872; p<0.001; cut-off=121.4 associated with an overall accuracy=79.6%, sensitivity=95.5%, specificity=66.7%,NPV=94.8% and PPV=70.0%). Ktrans had the second highest AUC=0.836 (p<0.001; cut-off=0.034 associated with anoverall accuracy=79.6%, sensitivity=86.4%, specificity=74.1%, NPV=87.0% and PPV=73.1%). The other factors foundto be acceptable diagnostic parameters for borderline/malignant lesions included WIR (AUC=0.816; p<0.001), iAUC60(AUC=0.808; p<0.001), Vp (AUC=0.795; p<0.001), SI max (AUC=0.737, p=0.005), SI peak (AUC=0.737; p=0.005)and Kep (AUC=0.681; p=0.031). Conclusion: Quantitative DCE-MRI is a relevant tool for differentiating benign frommalignant adnexal masses. Among all the DCE parameters, SI rel and Ktrans are the most accurate discriminators.     

Targeted and Systematic Biopsy for Diagnosis and Management of Prostate Cancer

The value of multi-parametric magnetic resonance imaging in the detection of clinically-significant prostate cancer is increasingly well-established, and has been adopted in current diagnostic pathways and clinical guidelines. Concurrently, the role of conventional ultrasound-guided systematic prostate biopsy is increasingly questioned. In this brief review, we evaluate the continued value of systematic biopsy including a review of prospective studies on targeted and systemic biopsies in the same patients. We also address current limitations of multi-parametric magnetic resonance imaging of the prostate.     

MR Imaging-guided Focused Ultrasound Surgery of Breast Cancer: Correlation of Dynamic Contrast-enhanced MRI with Histopathologic Findings

PURPOSE: To assess the value of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) parameters to monitor residual tumor following non-invasive MRI-guided focused ultrasound surgery (MRIgFUS) of breast tumors. METHODS: DCE-MRI data were acquired before and after the MRIgFUS treatment of small breast tumors (d < 3.5 cm) for 17 patients. The lesion was surgically resected and the presence of residual tumor was determined by histopathological analysis. The percentage of residual tumor was correlated with three DCE-MRI parameters measured at the maximally enhancing site of each tumor: increase in signal intensity (ISI), maximum difference function (MDF) and positive enhancement integral (PEI). RESULTS: A good correlation was found between the ISI (r = 0.897), MDF (r = 0.789) and PEI (r = 0.859) parameters and the percentage of residual viable tumor determined by histopathology. A receiver operator characteristic curve analysis yielded a cutoff value for ISI at 20% with a sensitivity of 77% and a specificity of 100%. CONCLUSION: These results suggest that parameters from DCE-MRI data could provide a reliable non-invasive method for assessing residual tumor following MRIgFUS treatment of breast tumors.     

磁共振在前列腺癌诊断与分期中的作用

前列腺癌的治疗效果与临床分期密切相关。回顾性分析经MR检查的25例前列腺癌，结果：原发灶中T2WI图像结节性病变占88％（22／25），均为混和信号结节，其中相对低信号结节72．7％，相对高信号结节27．3％。45．5％（10／22）的结书可以判别肿瘤所属的解剖分区。与Whitmore－Jeweet标准的临床分期比较，本组MR分期的总符合率为84％（21／25），区分A／B期与C／D期的敏感性为92％。结合文献本文认为MR诊断A、B期前列腺癌缺乏特异性图像，仅可作为筛选方法之一。MR分期总的可靠性较高，对肿瘤精囊浸润的判断有一定价值，但对镜下包膜侵犯及盆腔淋巴结转移的显像MR仍有局限性。     

肝门区胆管癌的MRI应用价值

目的探讨肝门区胆管癌(HC)的MRI检查技术及应用价值。方法HC34例所有病例均行MR一体化扫描,包括MR平扫、MRCP、MR动态增强血管成像(3D-DCE-MRA),并作出能否手术切除的评价,与手术结果相对照。结果34例HC均可见肝门肿块、肝内胆管扩张、肝门胆管中断,动态增强扫描31例表现为延迟强化,3D-DCE-MRA中6例在动脉期表现为螺旋样动脉,18例可见门静脉受侵,表现为门脉侧壁浸润、门脉缩窄或闭塞,MRI对能否手术切除评估的准确性为88.2%(30/34)。结论MRI检查能充分显示HC病变及其侵犯范围,对HC进行准确的诊断和术前评估。     

肝门区胆管癌的MRI应用价值(英文)

目的探讨肝门区胆管癌(HC)的 MRI 检查技术及应用价值。方法 HC 34例所有病例均行 MR一体化扫描,包括 MR 平扫、MRCP、MR 动态增强血管成像(3D-DCE-MRA),并作出能否手术切除的评价,与手术结果相对照。结果 34例 HC 均可见肝门肿块、肝内胆管扩张、肝门胆管中断,动态增强扫描31例表现为延迟强化,3D-DCE-MRA中6例在动脉期表现为螺旋样动脉,18例可见门静脉受侵,表现为门脉侧壁浸润、门脉缩窄或闭塞,MRI 对能否手术切除评估的准确性为88.2%(30/34)。结论 MRI 检查能充分显示 HC 病变及其侵犯范围,对 HC 进行准确的诊断和术前评估。